Chatzipanagiotou Odysseas P, Woldesenbet Selamawit, Munir Muhammad Musaab, Catalano Giovanni, Khalil Mujtaba, Rashid Zayed, Altaf Abdullah, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Surgery, University of Verona, Verona, Italy.
Ann Surg Oncol. 2025 Feb;32(2):1199-1209. doi: 10.1245/s10434-024-16373-8. Epub 2024 Nov 1.
Historically, housing policies have perpetuated the marginalization and economic disinvestment of redlined neighborhoods. Residential segregation persists nowadays in the form of contemporary redlining, promoting healthcare disparities. The current study sought to assess the effect of redlining on oncological outcomes of patients with gastrointestinal cancer and identify mediators of the association.
Patients with colorectal or hepatobiliary cancer were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2007-2019). The contemporary redlining index, a measure of mortgage lending bias, was assessed relative to disease stage at diagnosis, receipt of appropriate treatment, textbook outcome, and mortality. Mediation analysis was used to identify socioeconomic, structural, and clinical mediating factors.
Among 94,988 patients, 32.2% resided in high (n = 23,872) and highest (n = 6,791) redlining census tracts compared with 46.2% in neutral and 21.6% in low redlining tracts. The proportion of Black, Hispanic, and White patients experiencing high and highest redlining was 65.9%, 41.6%, and 27.9%, respectively. Highest redlining was associated with 18.2% higher odds of advanced disease at diagnosis, greater odds of not undergoing surgery for localized disease (adjusted odds ratio [aOR] 1.363, 95% confidence interval [CI] 1.219-1.524) or not receiving chemotherapy for advanced disease (aOR 1.385, 95% CI 1.216-1.577), and 26.7% lower odds of textbook outcome achievement. Mediation analysis for appropriate treatment quantified the proportion of the association driven by socioeconomic status, racial/ethnic minority status, racial/economic segregation, primary care shortage, and housing/transportation.
Contemporary redlining contributed both directly, and via downstream factors, to disparities in oncological care and outcomes of patients with gastrointestinal cancer.
从历史上看，住房政策一直使被划定为红线区域的社区处于边缘化状态并减少了对其的经济投资。如今，居住隔离以当代“红线划定”的形式持续存在，加剧了医疗保健方面的差距。本研究旨在评估“红线划定”对胃肠道癌患者肿瘤学结局的影响，并确定这种关联的中介因素。
从关联的监测、流行病学和最终结果（SEER）-医疗保险数据库（2007 - 2019年）中确定结直肠癌或肝胆癌患者。相对于诊断时的疾病阶段、接受适当治疗情况、理想结局和死亡率，评估当代“红线划定”指数（一种衡量抵押贷款偏见的指标）。采用中介分析来确定社会经济、结构和临床中介因素。
在94,988名患者中，32.2%居住在高“红线划定”（n = 23,872）和最高“红线划定”（n = 6,791）的人口普查区，而居住在中性“红线划定”区的占46.2%，低“红线划定”区的占21.6%。经历高“红线划定”和最高“红线划定”的黑人、西班牙裔和白人患者比例分别为65.9%、41.6%和27.9%。最高“红线划定”与诊断时晚期疾病的几率高18.2%、局部疾病未接受手术的几率更高（调整优势比[aOR] 1.363，95%置信区间[CI] 1.219 - 1.524）或晚期疾病未接受化疗的几率更高（aOR 1.385，95% CI 1.216 - 1.577）以及理想结局达成几率低26.7%相关。对适当治疗的中介分析量化了由社会经济地位、种族/族裔少数群体地位、种族/经济隔离、初级保健短缺以及住房/交通因素导致的关联比例。
当代“红线划定”直接并通过下游因素导致了胃肠道癌患者在肿瘤治疗和结局方面的差异。
